When to Consider Measure Harmonization

Measure developers should consider both harmonization and alignment throughout the Measure Lifecycle and whether to respecify an existing measure, adopt an existing measure, or develop a new measure.

Registry developers and measure developers of registry measures should share and/or harmonize similar measures unless there is a compelling reason not to do so. Harmonization among registries provides clinicians with a larger cohort for comparison for performance scoring and benchmarking. 

Measure developers should consider harmonization when

  • developing measure concepts by
    • conducting a thorough environmental scan to determine whether there are appropriate existing measures on the topic
    • consulting with a technical expert panel (TEP) and obtaining public input on the topic and the measures
  • developing measure specifications by examining technical specifications for opportunities to harmonize
  • conducting measure testing by assessing whether the harmonized specifications will work in the new setting or with the expanded population or data source
  • implementing measures by proposing the harmonized measure for use in new programs
  • conducting ongoing measure monitoring and evaluation by continuing environmental surveillance for other similar measures

The table summarizes ways to identify whether measures are related, competing, or new, and indicates the appropriate action based on the type of harmonization issue.

Harmonization Decisions during Measure Development

MeasureHarmonization IssueAction

Numerator: Same measure focus

Denominator: Same target population

Competing measures
  • Use existing (adopted) measure or justify development of an additional measure
  • A different data source will require new harmonized specifications (e.g., respecified)

Numerator: Same measure focus

Denominator: Different target population

Related measures
  • Harmonize on measure focus (i.e., respecified)
  •  Justify differences
  •  Respecify existing measure by expanding the target population

Numerator: Different measure focus

Denominator: Same target population

Related measures
  • Harmonize on target population
  • Justify differences

Numerator: Different measure focus

Denominator: Different target population

New measures
  • Develop a de novo measure

The measure developer decides whether to develop a new measure by first conducting an environmental scan for existing similar or related measures and searching the CMS Measures Inventory Tool (CMIT) (for measures in development or planned for development), the CMS CBE’s Submission Tool and Repository (STAR) Measure Database  and Qualified Clinical Data Registry (QCDR) lists of measures. To review QCDR measures, go to the Explore Measures & Activities  website and find the QCDR Measure Specifications. If the information gathering process and input from the TEP determine no similar or related measures can be respecified or adopted, then it may be appropriate to develop a new measure. The Information Gathering section provides details on this process. 

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